Let’s talk about acne popularly known as pimples

By Dr Brighton Chireka
Acne (popularly known as pimples) is a common skin condition that affects most of us at some point. It causes spots, oily skin and sometimes skin that’s hot or painful to touch. Acne is very common in teenagers and younger adults. About 80% of people aged 11 to 30 are affected by acne. It is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19. It often disappears when a person is in their mid-twenties. Unfortunately in some cases it can continue into adult life . About 5% of women and 1% of men have acne over the age of 25. Acne usually affect the face but may affect the back , neck and the chest. Inflamed pimples need to be treated early to prevent scarring.

What causes acne

Let’s look at the picture above

If you look at the picture about you will see that under the skin surface we have small sebaceous glands. These glands produce oil ( sebum) that keeps the skin supple and smooth . If you look again on the skin surface you will see pores (holes). These pores on the skin allow the oil to come on to the skin surface . Hair also grows through the same pores .

What happens during the teenage years ?

During teenage years people make more oil due to changes in hormones at puberty . The more oily one makes the more acne they get.

Types of acne and how it is caused

1-Mild to moderate acne
This is composed of blackheads, whiteheads and small pimples . Some pores on the skin become blocked due to the skin at the top of the pores becoming thicker in combination with dead skin that is shed into the pores . Plugs that block the top of the pores can be seen as tiny spots known as blackheads and whiteheads .Please note the black of the blackheads is due to skin pigment and is not dirt as people may think .

Some oil may collect under the blocked pores forming small spots called this pimples or papules. 2-Moderate to severe acne
This is composed of large spots and inflammation. On our skin we have bacteria called Propionibacterium acne ( P acnes) in small numbers and it’s harmless. The trapped sebum (oil) is good food for this bacteria P acnes . If there is more oil trapped in a blocked pore this bacteria multiply . When it multiplies our immune system reacts and cause inflammation . When inflammation occurs the skin becomes red and the spots become larger and get filled with pus . This can get worse into small nodules or cysts.

Rare causes of acne

Other diseases such as polycystic ovarian syndrome (PCOS) can cause acne . PCOS is a condition in women that causes excess male hormone to be made in the ovary or adrenal gland. It also causes thinning of scalp hair , excess growth of facial hair or body and other problems.

Another rare cause of acne is exposure to chemicals at workplaces ( halogenated hydrocarbons)

What makes acne worse?

1- Progestogen only contraceptive pill
2- Hormonal changes around periods can cause flare up of acne in some women
3-Thick or greasy make up may make acne worse, but most make up does not affect acne . You can use make up to cover some mild spots . Make up is different from SKIN LIGHTENING CREAMS
It is advisable to use non comedogenic or oil- free products
4-Picking and squeezing the spots may cause further inflammation and scarring
5-Sweating heavily make acne worse especially ladies working in hot kitchens preparing food for the family
6-Spots can develop under tight clothes eg headbands , tight bra straps , tight collars etc
7-Some medicines make acne worse for example , phenytoin used for epilepsy or Steroid creams used for eczema or high steroid dose SKIN LIGHTENING CREAMS

8-Anabolic steroids taken by body builders are not good . They make acne worse
9- There is no evidence to support that diets high in sugar or milk products make acne worse.

There are lot of myths and wrongly held beliefs about acne ( Pimples)

1- acne is not caused by poor hygiene . In fact, excessive washing may make pimples worse
2- stress does not cause acne
3- acne is not just skin infection . As explained above it is caused by interaction of changes in hormones , more oil production, overgrowth of harmless bacteria ( P acnes) , inflammation, etc as described above . You cannot catch acne so do not worry . It is not contagious.

4- acne cannot be cured by drinking a lot of water . ( drinking water is good for general health though )
5- no evidence that sunbathing or sunbeds help to clear acne
6 – some think acne cannot be treated . It can be treated – see your doctor . I will talk about treatment here as well

Skin care for people with acne 1- do not wash more than normal . Max wash should be twice a day and not to be obsessed about washing your face . ( very hot or too cold water may worsen acne)
Do not scrub hard when washing. Do not use powerful soaps . Use a soft washcloth and fingers instead . Excessive washing and scrubbing make acne worse
2- antiseptic washes may be beneficial

3-remember this, you cannot clean off blackheads . The black tip of a black head is actually skin pigment ( melanin ) and cannot be removed by cleaning

4 – use fragrance free , water- based moisturising cream . Do not use ointments or oil rich creams as these may clog the holes of the skin

Treatment of acne or pimples

Aim of treatment is to clear spots and prevent scarring
Various gels , lotions and creams are used to treat acne .
When applying creams make sure that you apply it to all affected area of skin and not to each spot .
Treatment can take weeks even months so do not give up easily. It is advisable to continue with any treatment for a least 6 weeks before deciding if it is working or not .
Remember acne can clear but does flare up every now and then . It is common to need maintained treatment for 5 years to keep acne away .

Types of treatment

Benzoyl peroxide is a common topical treatment . It has 3 actions
1- it kills germs
2- reduces inflammation
3- helps to unplug pores
In UK you can buy this medicine without a prescription.
It works best if you wash the skin 20-30minuted before use .
It may bleach hair , bed linen, or clothes that come in contact with it
Commonly causes mild skin irritation. If skin becomes irritated one must stop using the medication and sees a doctor as soon as possible .

Your doctor can prescribe retinoids which are good at unplugging blocked pores . Sometimes you make be given topical antibiotics which reduce the number of bacteria and inflammation. Unfortunately they do not have effect on unplugging blocked pores. Azelaic acid is an alternative and works on unplugging blocked pores

Combinations preparations can be used such as benzoyl peroxide plus an antibiotic or retinoid pulse an antibiotic.

Oral antibiotics can be used to clear inflamed acne but have little effect on unplugging blocked pores. If one has a lot of blackheads and whitehead as well as inflamed acne spots , it may be advised to try benzoyl peroxide in addition to taking an antibiotic tablet .
Antibiotics commonly used are tetracyclines based antibiotics . These include oxytetracycline , tetracycline ,doxycycline and lymecycline

The combined contraceptive pill can be used treat acne in some women. A variety of pill called co-cyprindiol is useful

Specialist treatment can be sort and they can use isotretinion tablets which reduce the amount of sebum made by sebaceous glands

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.